超声弹性成像评分法和应变比值法评估乳腺癌新辅助化疗疗效的价值分析  

Value of ultrasonic elasticity score and strain ratio in evaluating breast cancer neoadjuvant chemotherapy

作　　者：王砚 万财凤[1] 刘雪松[1] 王琳[1] 杜晶[1] 李凤华[1] 李红丽[1] WANG Yan;WAN Caifeng;LIU Xuesong;WANG Lin;DU Jing;LI Fenghua;LI Hongli(Department of Ultrasonic Medicine,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院超声医学科,上海市200127

出　　处：《临床超声医学杂志》2017年第12期797-801,共5页Journal of Clinical Ultrasound in Medicine

基　　金：国家自然科学基金项目(81571678);上海市科学技术委员会科研计划项目(14411968200);上海交通大学医学院附属仁济医院横向课题(RJKY14-07)

摘　　要：目的探讨实时超声弹性成像技术评估乳腺癌新辅助化疗(NAC)疗效的临床价值。方法收集在我院行乳腺NAC并手术的患者40例,分别于化疗前和术前行常规超声和实时超声弹性成像检查,应用超声弹性评分法和应变比值法(分别选取周围正常乳腺组织和脂肪组织作为参照)评估其NAC前后的弹性变化;以术后病理结果为金标准,应用ROC曲线分析并比较不同参照时应变比值法评估NAC疗效的截断值、曲线下面积、敏感性及特异性。结果 40例患者中,NAC结束后治疗有效者24例,无效者16例。有效者NAC后超声弹性评分≤3分者占87.5%(21/24),4~5分者占12.5%(3/24);无效者NAC后超声弹性评分≤3分者占31.2%(5/16),4~5分者占68.8%(11/16),二者比较差异有统计学意义(P=0.002);超声弹性评分法评估NAC疗效的敏感性、特异性分别为87.5%、68.8%。无论选取周围正常乳腺组织还是脂肪组织作为参照,有效者、无效者NAC前后应变比值变化比较差异均有统计学意义(P=0.001、0.005);以周围正常乳腺组织为参照时,弹性应变比值法评估NAC疗效的截断值为58.1%,曲线下面积为0.820,敏感性、特异性分别为79.2%、87.5%;以脂肪组织为参照时,弹性应变比值法评估NAC疗效的截断值为71.9%,曲线下面积为0.753,敏感性、特异性分别为83.3%、68.8%。选取不同参照时弹性应变比值法预测NAC疗效的曲线下面积比较差异无统计学意义(P=0.197)。结论超声弹性评分法和应变比值法均可作为评价乳腺癌NAC疗效的有效手段;且应用应变比值法时无论选取周围正常乳腺组织还是脂肪组织作为参照,其评估价值无明显差异。Objective To investigate the value of ultrasonic elastography in evaluating breast cancer neoadjuvant chemotherapy(NAC).Methods The study included40breast cancer patients who received NAC and surgical treatment.All of the patients underwent conventional and ultrasonic elastography before and after NAC.The images were analyzed by five-point elasticity scoring system and ultrasonic strain ratio method,and compared with pathological results.The area under the curve(AUC),diagnostic threshold,sensitivity and specificity of strain ratios were evaluated by ROC curves.Results In40patients,positive response was found in24patients,and non-positive response was found in another16patients.The low scores group(soft,scores from1to3)and high scores group(hard,scores4and5)were21and3respectively in positive response patients,and5and11respectively in non-positive response patients.There was significant difference(P=0.002).The sensitivity,specificity of ultrasonic elasticity score in evaluating NAC efficacy were87.5%,68.8%,respectively.There were statistically differences between positive response patients and non-positive response patients both in gland-to-lesion strain ratio(GLR)and fat-to-lesion strain ratio(FLR)(P=0.001,0.005).Taken GLR as a reference,the cut-off value of strain ratio in evaluating NAC efficacy was58.1%,the AUC was0.820,the sensitivity and specificity were79.2%and87.5%,respectively.Taken FLR as a reference,the cut-off value of strain ratio in evaluating NAC efficacy was71.9%,the AUC was0.753,the sensitivity and specificity were83.3%and68.8%,respectively.But the difference of AUC between GLR and FLR in predicting NAC efficacy was not significant(P=0.197).Conclusion Both ultrasonic elasticity score and strain ratio are helpful in evaluating the efficacy of breast cancer NAC.There is no difference in selecting the reference of GLR and FLR by strain ratio.

关 键 词：超声弹性成像 乳腺肿瘤 新辅助化疗 弹性评分 应变比值 

分 类 号：R737.9[医药卫生—肿瘤] R445.1[医药卫生—临床医学]